From the Guidelines
Incapresis is not a recognized medical term, and the closest medical term would be "encopresis," which refers to fecal incontinence or soiling in children who have already been toilet trained. Encopresis typically occurs when a child holds stool for too long, leading to constipation and eventual leakage of liquid stool around the impacted fecal mass.
Treatment Approach
Treatment involves:
- Clearing the bowel impaction (often with polyethylene glycol laxatives like MiraLAX at 1-1.5g/kg/day for 3-7 days) 1
- Followed by maintenance therapy with stool softeners, dietary changes (increased fiber and fluids), and behavioral modifications to establish regular toilet habits This condition requires medical attention as chronic constipation can lead to stretching of the rectum, reducing the sensation of needing to defecate.
Importance of Early Intervention
Addressing the problem early helps prevent psychological distress and social difficulties for the child. According to the American Gastroenterological Association, a gradual increase in fiber intake and the use of osmotic agents like polyethylene glycol can be effective in managing constipation, which is a key factor in encopresis 1.
Additional Considerations
Biofeedback therapy has also been shown to improve symptoms in more than 70% of patients with defecatory disorders, and may be considered for patients who do not respond to standard approaches 1.
From the Research
Definition and Prevalence of Encopresis
- Encopresis is defined as functional faecal incontinence at 4 years of age or older and affects 1-3% of all school children 2
- It is estimated to affect 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals 3
- Up to 3% of the pediatric population suffer from encopresis 4
Causes and Symptoms of Encopresis
- The etiology of encopresis is thought to be related to physiologic problems such as constipation 3
- Constipation is a common cause of encopresis, and it can lead to fecal incontinence 2, 5
- Encopresis can also be associated with psychiatric problems, such as behavioral disorders 2, 3
Treatment of Encopresis
- A symptom-oriented behavioral approach (toilet training) is most successful, with the addition of laxatives (polyethylene glycol) if constipation is present 2
- Medical management, including laxatives and fiber, can be effective in treating encopresis 4, 6
- Antegrade continence enema (ACE) is a surgical option for severe cases of encopresis, and it can be effective in reducing soiling and constipation 5
- Biofeedback is not effective in treating encopresis 2
Outcomes and Prognosis of Encopresis
- The long-term outcome of encopresis has been poor and needs improvement 2
- With proper treatment, 75% of children with encopresis can remain free of soiling, and the remaining 25% can have reduced soiling episodes 6
- ACE can reduce soiling, constipation, and need for fecal disimpaction, with a success rate of 79% 5